Primary care management	Consultation recommended
Fever with or without focus: prompt treatment with broad-spectrum antibiotics after cultures have been obtained; use a cephalosporin with or without vancomycin (Vancocin)	Persistent fever or a temperature of 39.4ºC (103ºF) or higher
	Signs of toxicity or meningitis
Pain: oral hydration, acetaminophen (e.g., Tylenol) with or without codeine, ibuprofen (Advil, Motrin), orally or parenterally administered morphine	Persistent pain in an extremity accompanied by acute signs of classic inflammation, increased temperature or positive blood culture
	Chest pain accompanied by persistently decreased oxygen saturation and/or radiographic findings
	Severe or persistent headaches
Respiratory symptoms with essentially normal oxygen saturation and negative chest radiograph: liberal administration of oxygen, incentive spirometer, bronchodilators	Low oxygen saturation
	Abnormal findings on the chest radiograph
	Dyspnea
Increased anemia: close observation and frequent evaluation of the complete blood cell count and reticulocyte count	Anemia accompanied by enlarging spleen, rapid worsening of anemia, or hematocrit less than 25 percent of baseline
Gross hematuria	First episode
Microscopic hematuria or proteinuria	Persistent hematuria or proteinuria
Right upper quadrant abdominal pain without cholecystitis or obstruction: symptomatic therapy	Recurrent abdominal pain with or without severe or increasing icterus
Asymptomatic gallstones: no treatment needed	Increased icterus
	Aseptic necrosis
	Central nervous system symptoms, including severe headaches and deteriorating school performance
	Leg ulcers
	Priapism